Individual
MR. RONNIE BRYON ISAACSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
4615 W EMERALD ST, BOISE, ID 83706-2002
(208) 917-1842
Mailing address
13825 PARAISO ST, CALDWELL, ID 83607-8088
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA191453
OR
363AM0700X
Medical Physician Assistant
Primary
PA-1707
ID
Other
Enumeration date
01/15/2019
Last updated
03/31/2022
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